Pan Staffordshire Health Economy

Strategic Estates Plan

DRAFT & CONFIDENTIAL: FOR DISCUSSION PURPOSES ONLY June 2016

Document status

In respect of any request for disclosure under the FoIA: This is a confidential document for discussion purposes and any application for disclosure under the Freedom of Information Act 2000 should be considered against the potential exemptions contained in s.22 (Information intended for future publication), s.36 (Prejudice to effective conduct of public affairs) and s.43 (Commercial Interests). Prior to any disclosure under the FoIA the parties should discuss the potential impact of releasing such information as is requested.

The options set out in the SEP are for discussion purposes. The involved NHS bodies understand and will comply with their statutory obligations when seeking to make decisions over estate strategies which impact on the provision of care to patients and the public. The options set out do not represent a commitment to any particular course of action on the part of the organisations involved.

Contents

1. Executive Summary 2. Introduction and Objectives 3. Methodology 4. Key Drivers and Challenges 5. The Current Estate 6. Vision for the Estate 7. Gap Analysis and Priorities 8. Summary of Opportunities 9. Outline Benefits Summary 10. Implementation and Next Steps 11. Appendices

Executive Summary

Where we are now? Where do we want to be? How do we get there?

The SEP is a pragmatic plan that will deliver change. This initial iteration sets out the current situation in Staffordshire. The next iteration of the SEP report will comprise: . Comprehensive review of the ‘as-is’ health estate, including utilisation; . Vison for future estate based on commissioning/service priorities; - List of priority estate projects for further analysis and implementation; - Summary of the likely clinical and financial benefits identified; - Summary of specific next steps; - Outline implementation programme.

Executive Summary • The Interim SEP, produced in December 2015, was a high level snap shot of Staffordshire at that time and focused mainly on primary care

• The LEF had only just been established and any estate work was in its early stages, linking as a workstream of the Pan Staffordshire Transformation Programme

• The Staffordshire health economy is committed to using the estate as an enabler to deliver long term savings, efficiencies and to support the introduction of new models of working

• Through this commitment, the health economy, together with the rest of the public sector, is working together to deliver a shared vision for the future of Staffordshire

• A lot of work has been carried out in the intervening 6 months and the future commitment, linked through the STP, is strong Executive Summary • Staffordshire is a big county, historically split between North and South, as to how it is managed, in terms of health, and public, services • Following on from the Mid Staffs issues, Staffordshire is now viewed by the NHS as a whole and the Pan Staffs Transformation Programme was set up to ensure this, bringing together the 6 CCGs • Estates is a workstream of the Pan Staffs Transformation Programme, led by NHS England • Primary care in the area is led by NHS England, with the CCGs encouraged to have a greater involvement • The first LEF in Staffordshire took place on 14 October 2015 following on from CHPs initial contact with Staffordshire in August • Current focus is on greater efficiency within the primary care estate • There are numerous exciting opportunities across the health economy to deliver services in a different way, providing both efficiency savings and better utilisation of existing properties.

STP

• The whole Staffordshire health economy makes up the footprint for the STP

• It is led by John MacDonald, Chair of the University Hospitals of North Midlands

• The full details of the STP are currently being discussed but it is anticipated that estates will be an associated workstream in the process, supporting the further integration of the new models of working, which is anticipated to see more local services being provided closer to home, instead of in hospital facilities Introduction and Objectives

The Pan Staffordshire Strategic Estates Plan (SEP) begins with a review of the healthcare estate so as to inform an emerging new strategic direction for the local health economy. The SEP is the initiative of the Staffordshire Local Estates Forum (LEF) which is comprised of the county’s Clinical Commissioning Groups (CCGs) working in partnership. It will inform a national, centrally-funded strategic healthcare estates development programme. This document is a “snapshot” of available information, including data that has been modelled to extrapolate the big picture and initial headline findings. It is a product of the ongoing process of collaborative development of the SEP involving the key stakeholders in the commissioning and provision of healthcare for the Pan Staffordshire health economy. The objectives of this document are as follows.  To identify indicative gaps in understanding and information.  To provide the data modelling that will enable alignment of commissioning service requirements and estates requirements in the next iteration.  To identify opportunities to improve the estate (eg utilisation and rationalisation) that could deliver benefits including clinical and financial.  To inform a system-wide view that is integrated with the principles of the One Public Estate Programme.

Methodology: the SEP Development Process

Step 3 The Estate that You Need (Vision)

Service Needs Step 4 Step 6 Vision for Technology Gap The SEP the Estate Analysis Population Changes Step 1 Gap Options Analysis Analysis SEP Getting

Prepared Estate Condition Step 5 Estate Options Capacity Estate Use Identification & Testing

Step 2 The Current Estate Stage 4 Strategic Stage 3 Implementation Gap Analysis Plan Stage 2 and Option Strategic Fit Appraisal Stage 1 Analysis Data Collection and Mapping Process Methodology – an integrated approach

The development of the SEP necessitates an integrated approach involving extensive consultation with a variety of stakeholders including the following. • Local Authority Forward Planning teams • County Council Infrastructure teams • Healthcare Provider estates leads – Acute, Community, Primary Care, Mental Health, • Healthcare Commissioners

Research undertaken includes the following key sources. • Local Authority Core Plans, Demographic Projections, Provider Strategic Plans • Major Housing & Economic Developments • Monthly Strategic Estates Group meetings • Strategic Healthcare Asset Planning and Evaluation (SHAPE) toolkit

Methodology: SEP developed by LEF chaired by CCGs

H&WBBs and system leadership groups

One Public Estate Programme Provider Trusts CCG NHSPS/CHP NHSE Local Estate Forum LIFTCo Local Authorities

Strategic Estate Adviser (from either CHP or NHSPS) Key Drivers and Challenges Drivers for Change Estates Impact

Population growth • Additional GP practices incorporated within community health facilities wherever possible. • Integration of GP and community care at scale, provided through multi-specialty centres. The financial challenge across the health • Estate savings and efficiencies needed to assist economy: must be addressed, but the quality reduction in spend on infrastructure. of service must also be maintained • Modern, purpose-built premises with bookable spaces for use by many providers will ensure quality of provision. Need to drive efficiencies via closer work • Integrated, multi-specialty healthcare centres with provider organisations provide potential solution, including greater efficiencies in administrative services. Pockets of multiple deprivation, with high • Use of the estate for preventative measures can levels of high-risk behaviours and multiple be achieved through reconfiguration. conditions • Multi-speciality centres needed for frail elderly and those with Long Term Conditions/complex needs.

Key Drivers for Commissioners and Providers

 Enhancing the patient journey with an improved quality estate, greater access to primary care and integrated community based services  Integration with local authority services is increasingly important and urgent  The NHS needs to identify significant revenue savings that cannot be found through efficiencies alone, but through whole system and service redesign with a specific focus on integrated health and social care, greater levels of care within communities and new commissioning models  A sustainable funding solution for estate improvements is required  Significant revenue cost and capital may be tied up in underutilised and inefficient estate which is often not in the right location to deliver the necessary services to the local population  Implementation of improved methods of clinical delivery through changing care models incorporating technology to provide patient care to a widely dispersed population and reduce costs  Key consideration of the One Public Estate and introducing drivers for change through collaborative working with other organisations

Overarching driving forces

 NHS Five Year Forward View  One Public Estate

 NHS England: A Call to Action  Better Care Fund

 Changes in Demography, Population  Health and Wellbeing Strategy

Growth and Deprivation  CCG/Provider Operational plans

National policy context relevant to Staffordshire CCGs In October 2014, the NHS published the Five Year Forward View, which detailed new models of care to integrate acute with Out of Hospital (OoH) services. The core principles contained within the view were:

 Give GP-led clinical commissioning groups (CCGs) more influence over the wider NHS budget, enabling a shift in investment from acute to primary and community services  Expand funding to upgrade primary care infrastructure and scope of services  Provide new funding through schemes such as the Challenge Fund to support new ways of working and improved access to services  Work with CCGs and others to design new incentives to encourage new GPs and practices to provide care in under-doctored areas to tackle health inequalities  Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.

The Pressures on Primary Care

General practice in England is under pressure. The traditional GP partnership model, which currently serves an average of around 6,650 patients per practice, is widely acknowledged to be too small to respond to the financial and demographic challenges facing the NHS.

Small practices have limited infrastructure to improve access and address variations in quality. They are vulnerable to marginal reductions in income and have insufficient staff to respond to new clinical, administrative and regulatory demands. Policies to avoid hospital admissions and discharge people earlier from hospital have resulted in more acutely ill people needing care in the community. But small practices may struggle to provide high-quality care for these patients because they lack formal links with other services and organisations. The resulting pressure on GPs, and frustration for patients and carers as they move between poorly coordinated teams of professionals, has been well documented.

Seven-day Working: ‘Whole System’ Approach Needed

Staffordshire recognises that there is a need to undertake a review of current capacity and access to GPs and to identify barriers to access and potential solutions. The model of care that is developed needs to recognise the importance of developing a ‘whole systems’ approach, taking into account developments with GP-Led Health Centres and Out Of Hours (OoH) services. Provider networks are a key strength and Staffordshire plans to develop these further, exploring closer working through collaboration, supporting each other to improve patient care and experience. This ‘whole system’ approach is shown below.

The NHS Five Year Forward View identifies four models that may be applied in New Models of Care addition to the initiatives to create GP federations, networks and ‘super partnerships’. Multispecialty Community Providers The two most directly relevant to OoH Primary and Acute Care Systems services are described as Multispecialty Community Providers (MCPs) and Primary and Acute Care Systems (PACs). (The details of these models are still emerging: a number of areas across the country are developing prototype MCPs and PACs in 2015/16.)

• Larger GP practices that could • A new way of ‘vertically’ bring in a wider range of skills – integrating services In addition, the need is highlighted for including hospital consultants, • Increased flexibility for NHS nurses and therapists, employed Foundation Trusts to utilise their ‘enhanced health in care homes’ that will or as partners surpluses and investment to kick- • Shifting outpatient consultations PACs start the expansion of primary develop in-reach support and services and ambulatory care out of care MCPs hospital • Contractual changes to enable through partnerships with social care and • Potential to own or run local hospitals to provide primary care community hospitals services in some circumstances care homes. These are likely to influence • Delegated capitated budgets – • At their most radical, PACs could including for health and social take accountability for all health the way OoH services might go about care needs for a registered list – similar • Addressing the barriers to change to Accountable Care delivering the national strategy. to enable access to funding and Organisations. maximising use of technology. The two key models (MCPs and PACs) are outlined here. Primary Care ‘hubs’ Concept

Primary Care ‘Hub’ Consolidated GP practices (estimated 1500m2).

Primary Care ‘Hub Plus’ Consolidated GP Practices plus outpatient/integrated social care facilities (estimated 1500-2500m2). These could house additional “office based” specialties such as dermatology, rheumatology, neurology, additional obstetrics OPD services or integrated social care.

Community Asset/Primary Care Hub or wide Multispecialty Community Provider (MCP) – (estimated 2500m2+). Mixed-use centre housing Local Authority services (e.g. library, drop in centre), leisure facilities and primary care hub (or hub plus). Designing Services to Deliver Proactive Care

 To cope with growing demand, care needs to be better designed around the services which people already access every day. For example, people access community pharmacies for their healthcare every day, making it an ideal setting in which to deliver proactive care. In addition, many patients choose to attend hospitals for their primary care needs. (Therefore a strengthened primary care presence at acute hospitals could help provide the services people need, without further pressurising emergency care, and could facilitate patient registration at a practice of their choice.)

 New models of care should coordinate activity across groups of practices where the complexity of care and range of professionals involved is such that it requires a central focus for higher-intensity care coordination and frequent specialist input (e.g. complex frail elderly, people living with learning disabilities, people in care homes and prisons). This will create alternative access points for high-volume, low- complexity care services for minor ailments in order to free- up additional capacity in OoH estate. Defining a New Service Specification for General Practice

At the heart of the need to define and commission a consistent, patient-centred service for the Staffordshire population will be the development of a new service specification for general practice. Key stakeholders within the health and social care community will co-design approaches to improve the health and wellbeing of the local population. This will be planned in close collaboration with service users – particularly patients with long term conditions. The objective will be to ensure that patients experience services that are truly seamless. Through partnership working with other providers and taking a ‘whole systems’ approach, high-quality, cost-effective care will be provided in the right place at the right time. For primary care provision to thrive and deliver a specification for care that patients need and value, the new model of care needs to encompass the three characteristics that matter most to patients: proactive coordination of care; accessible care; coordinated care. The characteristics proposed are detailed in the following table.

Key Characteristics by Work Stream for Primary Care Practices Accessible Care Proactive Care Co-ordinated Care Urgent Care Long Term Conditions Complex & Frail Elderly Key Outcome Services respond to all patients with Supporting people to live well Patient-centred, coordinated, seamless different access needs care

Patient’s The right service at the right time with Continuity of care across the care A named clinician who routinely provides appropriate access pathway with smooth transitions care and acts as an advocate, guide and Expectations contact for the extended practice team and to the wider multidisciplinary team in line with their needs Response Time Urgent / Same day Routine Routine Extended hours and 7 day access Urgent care for exacerbations Planned Urgent Workforce Model Appropriately qualified professional able to Self-care / expert patient Core GP workforce respond to urgent request Wellbeing / Community Navigator Extended primary care teams Integrated with 111 and Out of Hours Extended primary care team Residential / Nursing Home support service New workforce models Palliative Care Teams Overseen and supported by GPs Supported by community consultants Community consultants Community specialist care Commissioning Core capacity in primary care plus flexible Commissioned as a single integrated Commissioned through GP contracts capacity from co-commissioned services pathways – always encouraging care Supported by extended primary care and Footprint over 7 days delivery at the ‘lowest’ level other health and social care teams Reduce complexity Characteristics Access is personal and responds to all Pyramid of management or RAG rated Core GP work with GP taking lead patients’ different needs at different times. levels of care responsibility for care coordination, Patient enabled to provide self-care with management of multi-morbidity, risk Patients are encouraged to use the most coordinated care across pathway management and holistic approach. appropriate service for their needs supported by community consultant Active case management Requires defined longer appointments

Enablers for Change It is likely that general practices will need to Clinical Enabler work together to form larger primary care organisations if services are to improve • Clinical support • Population health sufficiently. This SEP review of the number and services informatics type of practices and other buildings will give • Maternity and • Workforce planning groups of practices the opportunity to focus on newborn • Organisational • Children and young development/clinical population health and provide extended people leadership opening hours whilst protecting the offer of • Surgery • Estates and facilities local, personal continuity of care. These • Pathway redesign management organisations are likely to align to a single • Urgent and emergency • Long-term financial population catchment or locality with other care coordination management health, social, community and voluntary • Primary care organisations. The shared organisation will • Integrated care • Mental health enable provision of a wider range of services including diagnostics; shared infrastructure, expertise and specialists e.g. for mental health In a limited number of areas, health can be or children; create new career paths; training co-located with local authority services and leisure and learning together. facilities to produce an integrated community health resource. Workforce planning Within each GP Aligned to each practice and working across a practice wider geography / at-scale primary care organisations

GPs, practice nurses, Prescribing advisors, GPs with a special interest GP nurse practitioners (GPSIs), care coordinators, wellbeing teams, /nurse prescribers, and ‘super practice managers/ directors’ with The working environment will be designed to enable multi- volunteers, sufficient skills to lead the development and disciplinary team working. receptionists, operational management of at-scale primary Given the growing population and managers, health care care organisations. skills-gap challenge, a sustainable assistants. May also As part of, for example, a wider MCP: workforce model needs to be include physician developed. Innovation will be key to secondary care specialists, social care, mental success. associates. health and community services teams and New roles such as physicians’ community pharmacy. assistants and general practice Health coaches and care navigators to become fundamental members pharmacists can be introduced and of multi-disciplinary health and social care teams that operate out of encouraged. shared facilities. In future, specialists who currently The GP recruitment and retention challenge is complex and needs to spend most of their time working in be overcome in terms of national initiatives, workforce redesign, hospitals are likely to spend more premises, primary medical care business model and role development time working in the community. which can span organisational boundaries. Next Steps Engaging with staff and key stakeholders  Activity modelling and capacity analysis across around the interim strategy, gaining feedback all the sites, bringing together the net impact of on the overall document, as well as the draft all the proposed models of care, so we can supporting work stream detailed chapters as establish the net bed/estate requirements on they are developed (which will be released in each site across the next 5-10 years in the full report). conjunction with changing population and demand

This will include shaping the patient and public  Detailed financial modelling and costing, engagement as an intrinsic element of including implementation costs and benefits for continuing development of the SEP as a ‘live’ each proposed PCTF bid and other schemes, document. ensuring alignment with income and expenditure plans, so we can establish a clear Testing the strategy with workforce modelling, net benefit of the strategy by year to ensure we have a better understanding, including the numbers of new roles and how  Implementation planning, providing an overall this work aligns to staff improvement work. phased and prioritised programme of change across the next five years. This will include working on the interdependencies of staff improvement plans in the different workstreams on each other (including enabling workstreams for IT, Estate, Workforce and funding mechanisms/incentives)

Confirm structure and associated governance for all aspects of the local health economy to engage with each other and the process

 In addition to the use of pre-existing forums  Continued facilitation of the process to ensure momentum gained in recent weeks isn’t lost  Further develop the strategic process to ensure service delivery plans currently being finalised can be incorporated into the clinical/infrastructure data analysis process and drive the modelling A tandem approach to process accordingly. ‘top down, bottom up’ will be crucial to successful ‘ Top-down’ approach in parallel with and implementation of the SEP reflecting the significant work undertaken to date from a ‘bottom up’ perspective’

This will ensure that an understanding is gained of the immediate infrastructure needs from an investment perspective.

Marrying up the two perspectives will ensure that the implementation of the SEP will create the right infrastructure in the right place delivering the agreed and ratified approach to clinical service delivery across the primary care sector whilst fully reflecting the requirements of the wider health economy and local authorities.

Supporting the leadership with the Confirmation and implementation of capability required centralised services will be important in areas such as long- to support the future phase of the programme will term conditions that have a major impact on space and acute bed ensure: occupation numbers Capacity confidence within primary and community care settings to deliver the care expectations as a result of care pathway redesign and transfer of care Integrated services across some sites will provide from acute into the community. opportunities to maximise current under-utilised facilities and This will involve reaffirming what services will be release space in other areas with a shift to the agreed point of delivered where and how much space is required in delivery. It is essential that these sites are identified to maximise the the following areas: opportunities. . Healthy Living Centres . Community Hospitals . Voluntary Organisations Priority areas: . Private Sector 1. Integrated care and Care Management . GP Practices 2. Integrated Commissioning . Child Development Centres 3. Community Health Services . Acute Provider Facilities 4. Urgent Care and Ambulatory care 5. The Development of GP Provider

These priorities are underpinned by clinical priority areas: 1. Care for Older People 2. Mental health 3. Diabetes as part of long term condition management 4. Child and Maternity Care 5. Cancer Stakeholder Engagement

Effective stakeholder engagement is crucial to the success of the development of the SEP.

The SEP development team will continue to engage with stakeholders and partners via a Strategic Communications Programme to be defined in early 2016 as part of the process of delivering the final S E P.

All proposals for schemes will be developed collaboratively, so that bids for funding are backed by Business Cases that enjoy the full support of key stakeholders and partners. Data category Data field Property Location and Tenure • Property Name • Property Ref • Street Address • Location Town Information • Postcode • Coordinates • CCG Management: the • CCG Code • Ward • Lead NHS Organisation • Property Tenure Property Data • LPA Lease Expiry Date • Date of Next Lease Break Asset Information • Holding Area (m2) Mastersheet • Main Occupation Category • Opening Hours • Is list of services provided from the site known? • Is Building Utilisation Actively Measured? • Total Estimated Void Space (m) Working with • Estimate of overall building utilisation • Has Building Been Assessed in Last 2 Years • Assessment Tool Available partners and • General Assessment Condition RAG stakeholders, the Commercial • Capital Value of Owned Asset (£) SEP development • Total Annual Property Occupation Cost (£) • team and its Annual Occupation Cost per m2 (£) Initial Estate Hypothesis • Property Category • Comments Professional Additional Information • List size 2013-2015 • Projected list size to 2017 (surplus to SHAPE requirements) • Type of GP Business Estates Advisors • 6 Facet Survey Information • Office Space % will maintain a • Clinical Space % • Other % • Age comprehensive • Capital works/backlog Maintenance • Services Provided Property Data • Property/service expansion, improvement or refurbishment needs as indicated by the practice manager • Number of Clinic Rooms Mastersheet • Number of Treatment Rooms • Number of Admin Rooms • Was an application for 2014/15 Primary Care Infrastructure (PDM) Fund made? • Will an application for 2015/16 Primary Care Infrastructure be made? Summary of Priority Initiatives

• The following slides highlight the key priority initiatives for each CCG in terms of estate to optimise, estate to reduce and estate to exit

• These are the current top priorities but the full list of priorities per CCG can be found on slides 81 – 83 and 87

• Although most of these priorities are linked into the ETTF process, not all are, and this is reflected in the following slides Summary of Priority Initiatives

Model Community Primary

Weeping Cross HC - not fit for purpose. Developer approached practice to build new 13 room HC. Potential to incorporate John Amery Drive Practice.

Russell House - Current facility no longer fit for purpose. Vision to develop a shared facility with SSOTP Great Wyrley - Health Centre not fit for purpose, ESTATE TO single hander practicfe across road. Proposal to New build required in Pattingham branch surgery (not ETTF) REDUCE/EXIT merge/relocate within 3 years (not ETTF) Colliery Practice - extension to branch surgery (not ETTF) Mansion House, Stone - extension Rising Brook Practice - plan to build new surgery Willow Bank/Longton Hall - new development to accommodate 4 practices Combined facility in Perton, 2/3 practices and possible community services Summary of Priority Initiatives

Model Community Primary

Castlefields - Plan and requirement for consulting/treatment room and consulting space Gravel Hill - small extension to enable practice to become Carlton St - Colocation of two practices initially in training practice and ensure reception confidentiality to purpose built primary care hub, which would be Hazeldene Surgery, Great Haywood - new build required able to expand to increase number of practices Potteries Medical Centre/Cambridge House Surgery - and/or services to support the development of Merging of practices and new build premises ESTATE TO primary at scale INCREASE Moss Grove Kinver - practice in poor state of repair and needs resolving (not through ETTF) Tri-Links - extension to main site surgery and branch surgery Northern Staffordshire GP Federation - To develop to provide additional clinical space for increased capacity. Will a GP-led urgent care/primary care centre HUB support practice with future planned housing growth Opposite RSUH A&E at Child Development Centre or a build attached to the ED Summary of Priority Initiatives

Model Community Primary

Burntwood HC - 2 new health centres to bring 4/5 Lichfield - Westgate Practice looking to relocate with Cloisters practices together. South Burntwood (Greenwood Practice to accommodate increasing patient popultation House, Spires and Fulfen practices); North Burntwood (BHWC, Salters Meadow and possible Boney Hay practices) Moorlands Medical Centre - Extension of current premesis and addition of ambulance entrance and exit ESTATE TO Wolstanton Medical Centre - Divide a ground floor OPTIMISE Holmecroft Surgery - extension required for additional space clinical room into two new clinical rooms and Stoke-on-Trent - Mayfield Practice - short term - reconfigure convert a large ground floor room into a new building, link in with Longton Cottage for support. Long term - clinical room. Providing 2 additional clinical rooms, purpose build for merging/colocation of single-hander GPs in increasing clinical capacity, enabling greater area training capacity for GP retention and improving access especially to the disabled Belgrave Medical Centre - 2 schemes involving additional consulting rooms and internal changes Current Estate – Overview Maps

Pan-Staffordshire Cannock Chase East Staffordshire North Staffordshire South East Staffordshire and Seisdon Peninsula Stafford and Surrounds Stoke-on-Trent Estate Review Summary Gross internal area of the GP estate is currently only known for LIFT sites, so an analysis of the total space and segmentation by operator cannot be completed at this stage. List size information has been provided for some of the non- LIFT GP estate. The figure indicates the total list size by CCG. This information is correct as of October 2015 and will be updated inline with the next phase of the Total known list size for each of the Pan-Staffordshire CCGs SEP moving into June 2017 Further analysis of the information provided to date regarding the GP estate has been completed to begin to identify any trends which require a particular focus. This initial analysis has looked at the number of full time equivalent GPs in comparison to total list size and benchmarks any known list sizes against the NHS England recommended list size of at least 10,000-15,000 patients. The results of this analysis can be seen in the following figures.

Total known list size against total number of GP fulltime equivalents for each of the Pan-Staffordshire CCGs All sites mapped on SHAPE for which both list size and number of GP fulltime equivalents are known have been included in the analysis. There is a steep positive correlation between CCG total list size and number of GP fulltime equivalents. A positive correlation would be expected, but its steepness may indicate the presence of many smaller GP practices rather than larger consolidated sites. The subsequent figures present the list sizes for individual primary care sites, where this information is known. The data is presented by CCG and the grey shading highlights the NHS England recommended list size to benchmark sites against this. Cannock Chase Total known list size for Cannock Chase CCG practices benchmarked against NHS England recommended list size where known North Staffordshire Total known list size for North Staffordshire CCG practices benchmarked against NHS England recommended list size where known East Staffordshire Total known list size for East Staffordshire CCG practices benchmarked against NHS England recommended list size where known South East Staffordshire and Seisdon Peninsula

Total known list size for South East Staffordshire and Seisdon Peninsula CCG practices benchmarked against NHS England recommended list size where known Stoke-on-Trent Total known list size for Stoke-on-Trent CCG practices benchmarked against NHS England recommended list size where known Stafford and Surrounds

Total known list size for Stafford and Surrounds CCG practices benchmarked against NHS England recommended list size where known Insufficient estate to Maximising use of the Analysis of the current estate is meet demand 'core estate' a key element of the SEP in Void space in long term Rationalisation and disposal of surplus or unfit core buildings order to identify the current estate estates challenges and map out Under-utilised Improving effective bookable space utilisation of the estate a deliverable implementation Inappropriate tenants Ensuring appropriate plan which will assist in utilisation of core clinical

Estates Aims achieving the core aims of the Under-utilised clinical space Estates Issues space Delivering new models of Staffordshire Primary Care Lack of joint working care Strategy – for which the estate across organisations Partnering across is a fundamental facilitator. organisations In the absence of information relating to Gross Internal Area, the initial analysis of list size suggests that the Pan-Staffordshire estate is providing primary care from many smaller practices in relation to the NHS England recommended list size. The majority of sites for all CCGs in the Pan-Staffordshire area have a list size below this recommended level. When a greater wealth of information relating to the primary care estate is provided, combining this analysis with other data such as condition, gross internal area and utilisation of the site will allow identification of key sites for strategic prioritisation and potential sites for consolidation (for example, larger under-utilised sites in good condition and with a small list size which could accommodate a larger list or small co-located sites in poor condition which could be consolidated into a primary care hub-type model). Overview of GP Estate The following GP estate is currently mapped on SHAPE (including branch surgeries).  10 LIFT  24 NHS Stafford and Surrounds CCG  22 NHS East Staffordshire CCG  40 NHS Cannock Chase CCG  41 NHS South East Staffordshire and Seisdon Peninsula CCG  65 NHS Stoke-on-Trent CCG  45 NHS North Staffordshire CCG Only the Gross Internal Areas of LIFT sites are currently known. The largest of these are:

Cobridge Primary Care Biddulph Primary Care Fenton Health Centre Centre Centre Stoke on Trent CCG Stoke on Trent CCG North Staffordshire CCG 47,874m2 4,334m2 3,004m2

Meir Primary Care Shelton Primary Care Centre Centre Stoke on Trent CCG Stoke on Trent CCG 2,945m2 2,734m2 Tenure and Condition of GP Estate

The known information regarding condition and tenure to date has been gathered from the Pan-Staffordshire GP questionnaire so it is advised that this is verified through further condition reviews. There are some outstanding responses to the GP questionnaire across all CCGs, but the following table provides an overview of the tenure and condition of the sites for which information has been provided thus far. Tenure Condition of Property Number Leasehold Freehold Excellent Good Satisfactory Poor of % % % % % % responses Cannock Chase 13/31 77 23 31 46 23 0 East Staffordshire 20/22 40 55 25 45 20 0 North Staffordshire 20/37 20 70 20 70 5 5 South East 29/38 52 34 7 45 28 21 Staffordshire and Seisdon Peninsula Stafford & Surrounds 17/22 59 41 24 41 0 24 Stoke-on-Trent 37/61 62 32 27 38 32 3 Utilisation of GP Estate Utilisation rates are not currently known. It is recommended that utilisation reviews be undertaken, in particular for key strategic sites that the Strategic Estates Plan may identify. The Pan-Staffordshire GP questionnaire asked some notable questions to which the responses may give an indication as to the corresponding current utilisation, including:  Does the practice currently have capacity to increase the patient list size?  Would the practice wish to extend the property to meet increased demand from population growth? The table below indicates the percentage of respondents who answered ‘Yes’ to these questions. Capacity Number of Capacity to increase Desire to extend property to responses list size meet increased demand from % responding Yes population growth % responding Yes Cannock Chase 13/31 62 69 East Staffordshire 20/22 45 70 North Staffordshire 20/37 45 45 South East Staffordshire and 29/38 34 62 Seisdon Peninsula Stafford & Surrounds 17/22 47 76 Stoke-on-Trent 37/61 43 59 Void Space – a Key Challenge

The Staffordshire Primary Care Strategy (draft) highlights void space in long-term core buildings as being a key challenge that needs to be addressed.

Void space is currently only known for 10 LIFT sites. SHAPE data indicates that seven of these sites have an estimated void space of 0m2. The maximum void space is 40.5m2 and the average of known void space is currently 5.86 m2. However, further information is required to provide an accurate picture of the void space amongst the GP estate. Comprehensive Information is Required to Understand Where We Are Now

In order to address known issues and develop an implementation plan to work towards improvement of the estate, it is essential that additional information is received to feed into the ongoing process of SEP development. The information required includes:  Gross Internal Area  Utilisation  Condition (some condition information is included in the Staffordshire GP Questionnaire, but it would be recommended that thorough, objective condition reviews be undertaken in order to determine where clinical space is not fit-for-purpose)  Occupation of the site by provider (where there may be multiple providers)  Services provided from the site Much effort has been put into data collection and analysis to inform the SEP; however, the returned data is weak in the areas of cost, utilisation and condition. The LEF will pursue the missing information needed to inform the next iteration of the SEP report.

Headline findings – data analysis and stakeholder engagement

• Further data collection and analysis is required as soon as possible, particularly as regards cost, utilisation and condition of the estate, to inform the next iteration of the SEP. This should be addressed before future strategic commissioning/ transformation decisions are made by the LEF.

• Primary care estate – new models of care to be developed; opportunities identified for hub development alongside rationalisation of the estate; more opportunities to be sought on an ongoing basis using the mechanism of the SEP, which will be a ‘live’ document. New housing developments and population growth are a demand factor.

• Community estate – utilisation data to be gathered and analysed to inform potential rationalisation of community estate.

• Acute – interaction between primary, community and acute will foster targeted integration projects to allow care to be moved to community. New models of care to be developed and promoted.

• Engagement with wider public sector and Local Authorities is underway which will lead to development of joint opportunities and enable reaction to major population increase and housing developments. This should be fully supported by all stakeholders involved in the process of developing the SEP.

Current Estate – Summary of Key Themes

 LEF engagement with GP locality leads will enable potential projects that support the wider agenda to be identified and progressed.  The general direction of travel is towards integrated hubs bringing together GPs and community services, enabling rationalisation of existing estate and promotion of integrated working.  The operation of primary care ‘at scale’ is a key aspect of the NHS Five Year Forward View strategic direction, in order to create sustainable general practice for the future.  Pan-Staffordshire Estate and Technology Transformation Fund (ETTF) bids in early June 2016 will support this strategic direction.  Analysis of utilisation information for community sites will allow consideration of whether any rationalisation is possible across the community estate. Improved interaction between acute, community and primary care being fostered through the LEF forum and the process of developing the SEP will be an enabler for these discussions. This will link in closely with the STP  Opportunities will be sought to foster cross-sector working and to bring together functions from acute, community and primary care on developments both off- and on acute sites. This will enable the integration agenda and help towards moving services off acute sites and into the community.

Vision for the Estate – Responding to Population Change The current estate is under pressure to modify in order to successfully deliver new models of care. Key factors for consideration include:

 Population growth  Commercial development and industry

 Changing demographic  The need for a more efficient estate

 Housing development  Improving access to the estate

 Collaboration across organisations  Localised deprivation

Population Growth 2002-2012 Office for National Statistics (ONS) annual ward-level population estimates were used as a baseline for projecting population growth to 2022. Using this method the total Pan- Staffordshire population in 2022 is estimated to be 1,156,460; a growth of 54,434 from the 2012 baseline. The projections from 2012-2022 indicate the greatest percentage growth in the following local authority wards within the Pan-Staffordshire area. The percentage growth is shown alongside the absolute growth in population.

 Leomansley (76%; 5465)  Hagley (37%; 1695)

 Burton (57%; 2000)  Milford (34%; 1830)

 Ford Green and Smallthorne (42%; 2438) Local Authority District Ward Name Population Growth (%; absolute) Greatest Population Cannock Chase Hagley 37%; 1695 Hawks Green 23%; 1717 Growth – by Ward Norton Canes 11%; 809 As the local authority district and CCG East Staffordshire Burton 57%; 2000 Anglesey 26%; 1835 boundaries are not in alignment, wards Eton Park 19%; 1178 cannot be clustered easily in order to use Lichfield Leomansley 76%; 5465 the same methodology to project the St John’s 28%; 1768 Alrewas and Fradley 25%; 1485 total growth of each CCG population or Newcastle-under-Lyme Keele 20%; 850 identify the wards suggesting the greatest Town 16%; 810 population growth within each CCG. Thistleberry 8%; 471 South Staffordshire Huntington and Hatherton 19%; 956 Therefore local authority districts have Featherstone and Shareshill 13%; 743 been used as a basis for the modelling Wombourne North and 10%; 596 Lower Penn and the three wards indicating the Stafford Milford 34%; 1830 greatest growth from 2012-2022 have Forebridge 29%; 1533 been identified. Stonefield and Christchurch 26%; 1387 Staffordshire Moorlands Cheddleton 18%; 971 Leek South 14%; 772 These wards are summarised in this table Hamps Valley 9%; 153 Stoke-on-Trent Ford Green and Smallthorne 42%; 2438 – which also details the percentage and Blurton West and Newstead 25%; 1528 absolute growth for each. Etruria and Hanley 22%; 1495 Tamworth Wilnecote 17%; 1561 Spital 11%; 790 Bolehall 11%; 825 Local Plans – Strategic Housing Allocations Within Stafford, three Strategic Development Areas have The Plan for Stafford Borough (adopted in been identified, one each to the west, north and east of June 2014) provides for 10,000 houses between 2011 and 2031, Stafford, which will accommodate 2,000 houses, 3,100 in accordance with the following houses, and 600 houses respectively. In other words, of the development hierarchy: 7,000 houses allocated to Stafford, 5,700 are on three large  Stafford – 7,000 houses areas, with the balance of 1,300 pepper-potted across the  Stone – 1,000 houses rest of the town.  Key Service Villages (Gnosall, Eccleshall, Haughton, Hixon, Great The local plan identifies in map form the major housing and Little Haywood with Colwich, Barlaston, Tittensor, Woodseaves, allocations in Stafford and Stone. Weston, and Yarnfield) – 1,200 to be distributed between them  Rest of the Borough (hamlets and settlements in the rural areas) – 800 Strategic Housing Allocations (2)

The Lichfield District Council will plan, monitor and manage the delivery of at least 10,030 homes in Lichfield District between 2008 and 2029 and ensure that a sufficient supply of deliverable /developable land is available to deliver around 478 new homes each year. Lichfield District will seek to provide 70% of housing on previously developed land to 2018 and 50% thereafter. Housing development will be focused upon the following key urban and rural settlements: Lichfield City; Burntwood Alrewas; Armitage with Handsacre; Fazeley; Fradley;, Shenstone and Whittington; Adjacent to the neighbouring towns of Rugeley and Tamworth.

South Staffordshire: The Council will plan, monitor and manage the delivery of at least 3,675 homes in South Staffordshire between 2006 and 2027 and ensure that a sufficient supply of deliverable/developable land is available to deliver 175 new homes each year informed by the District housing trajectory. The Council will seek to maintain a 5 year housing supply of deliverable sites and to provide 60% of housing on previously developed land during the plan period.

Stoke-on-Trent City Council and Newcastle-under-Lyme Borough Council are currently developing a joint methodology in order to inform the Strategic Housing Land Allocation production. They have invited key stakeholders to help prepare a robust assessment of housing land availability across the two local authority areas to help them to robustly consider housing market trends in the Joint Local Plan.

Strategic Housing Allocations (3)

East Staffordshire: The Borough Council will provide for 11,648 dwellings over the plan period of 2012 2031. The housing requirement will be delivered in accordance with the following indicative average annual rate: 466 dwellings per annum for 6 years (2012/2013-2017/2018); 682 dwellings per annum for 13 years (2018/2019-2030/2031).

Staffordshire Moorlands: The 2008 Sub-National Household Projections predict that there will be an additional 5,150 households across the District between 2006 and 2026, which is equivalent to a net demand for an additional 5,300 dwelling units. Much of this will be to meet local needs generated by falling household size and demand from hidden households, although continuing immigration will also contribute to the increase in housing demand.

The Cannock Chase local plan provides for 5,300 new houses within the District between 2006 and 2028. 1,625 new houses were completed in the first six years. 2,350 new houses will be provided in the urban areas of the District, 66% in Cannock, Hednesford and Heath Hayes, 29% in Rugeley and Brereton and 5% in Norton Canes. Urban extensions within Cannock Chase District are identified via a strategic site west of Pye Green Road for 750 new houses (with potential for 900), and south of Norton Canes for 670 houses. A strategic development allocation to the east of Rugeley within the Lichfield District Local Plan contributes 500 houses to meeting the growth requirements of Rugeley and Brereton via the south-east Staffordshire strategy.

Mapping Areas of Multiple Deprivation

An awareness of the areas of greatest deprivation will be an essential consideration in development of the SEP due to the increased demand that this will place on primary care services.

The Index of Multiple Deprivation combines seven domains of deprivation and applies an appropriate weighting to each (for example, health deprivation and disability, income deprivation and barriers to housing and services). Pockets of Multiple Deprivation The average Index of Multiple Deprivation across the Pan-Staffordshire area is 20.47, which is just below the England average of 21.67. There are pockets of Multiple Deprivation (for example, East Staffordshire has six areas in Burton Upon Trent that are in the 10% most deprived in England due to the surrounding environment, income affecting older people and children, housing, crime and education). There is evidence of inequality in Multiple Deprivation across the area when comparing the Index of Multiple Deprivation for each CCG population then mapping the indicator on SHAPE: CCG Index of Multiple Deprivation East Staffordshire 18.02 Cannock Chase 19.68 North Staffordshire 17.32 South East Staffordshire and Seisdon 15.02 Peninsular Stoke-on-Trent 33.58 Stafford and Surrounds 13.15 Vision for the Estate – Commissioning Requirements

The key aims of the draft Staffordshire Five Year Primary Care Strategy are to commission high-quality primary care services that:  Improve patient outcomes and increase wellbeing  Reduce inequalities and unwarranted variation in primary care  Ensure access to primary care services is equitable  Support and empower people to look after themselves  Enable prevention and early intervention  Deliver an MCP model of care which enables care to be provided in the right place at the right time The strategy notes that “general practice is under strain and is bearing the brunt of pressures to meet increasing and changing health needs. This strategy sets out an ambitious and attractive vision of general practice that operates without borders, and in partnership with the wider health and care system. A patient and their GP should be at the heart of a multidisciplinary effort to deliver patient-centred coordinated care. This should occur in general practices which are recognised as centres in each neighbourhood, developing community resilience and supporting the population to stay as well and as healthy as possible.”

Developing a Healthy Estate  Make use of the development of the SEP as an opportunity to rethink the ‘whole’ estate of health and care services, allowing redesign along the lines of the new models of care and integrated services.  Enable the integration of health and care services and estates with communities, housing, schools, leisure facilities, green spaces and other settings, to create a healthy place.  Link health and care provision with housing: for instance, integrating care with housing to enable people to live independently and in their own homes, along with innovative residential care and flexible options between them.  Ensure the health and care estate encourages accessibility to services, through walking / cycling access, and public transport links.  Ensure the provision of health services, including locations and buildings, actively promotes physical activity, healthy eating and positive mental health and wellbeing. In addition, ensure the environment in and around the health estate connects with the neighbourhood and the community and is suitable for people of all ages and abilities.  Ensure health and care infrastructure allows for integration between primary and secondary care, mental and physical health, and health and social care. Provide more services closer to the patient, in their home or community, enabling people to manage their own health and care.

Components of a Healthy Estate In order to facilitate moves of care from the acute sector into the community, technology must be utilised to the full, with health hubs, telemedicine and interoperable IT systems being key considerations. Rationalisation of estate will be needed to realise efficiencies in terms of both capital receipts and reduced revenue costs to enable the CCGs to operate within their budgets and to reduce overspend. Any backlog maintenance will need to be eradicated through an improvement programme for the existing estate. Integration of primary care into acute and urgent care will also necessitate works to the existing estate. Review of the estate in terms of cost, condition and utilisation should be undertaken to determine any disposal opportunities. Opportunities to reduce the acute estate by moving care into community should be investigated taking a ‘whole systems’ approach. Gap Analysis – Summary of Key Themes

A detailed gap analysis will be undertaken for the next iteration of the SEP report. This will compare the current estate with the estate vision based on future commissioning requirements. It appears at this early stage that the following areas will require further consideration:

 Housing developments and population growth will require new integrated health facilities and greater inter-agency working between the local authorities and health and care communities.

 New models of shared care are to be developed with other care providers, including those working in the community, in hospitals, and in care and well-being services. Multi-specialty local clinical partnerships need to be developed that will integrate services across traditional boundaries. Such models of care will need to articulate the roles and responsibilities of general practice clearly. There is considerable scope to improve the quality of care co-ordination for patients with long-term chronic and mental illnesses, for those at the end of life, and in maternity care. Links between general practice and other services need to be strengthened in areas where patients with complex problems receive care from multiple providers. Development of a hub model (eg multi-speciality centres) incorporating primary care is required to provide a high-quality service to a growing population with complex healthcare needs: the estate cannot currently provide for the needs of the local population without change.

 The estate will be required to support an evolving skill-mix in general practice, to include a wider range of professionals working within and alongside it. The GP should no longer be expected to operate as the sole reactive care giver, but should be empowered to take on a more expert advisory role, working closely with other professionals. Capacity Modelling Capacity modelling has been undertaken to determine the infrastructure requirements for primary care across each of the Pan-Staffordshire CCGs and within the specific growth wards as indicated in the earlier table. The diagram below provides an outline of the process:

CCG Population National average for GP infrastructure Projections and 2022 GP consultation requirements for ward-level rates each CCG, Pan Output

Baseline population Level of deprivation Staffordshire as a projections and whole and wards housing Operational hours showing greatest development figures Clinical utilisation growth – including for each CCG and Gross Internal Area, Local Authority number of C/E and

District Considered Variables treatment rooms based on HBN 11-01

The table on the next slide outlines the variables and assumptions on which the modelling is based, along with the rationale where necessary. Variable Details of baseline to be used Rationale or Assumption Projected 2015-2022 1 year for mobilisation following LES finalisation plus 5 year strategic Period outlook Level of 1. CCG Population Modelling on a Local Authority Ward level allows for isolation of areas of particular growth due to demographics and housing developments modelling 2. Local Authority Ward Base 1. For CCG Population modelling – ONS CCG Population 1. As CCG and Local Authority District boundaries are not in alignment, population Projections wards could not be clustered to form an accurate picture of a projected CCG population to model the requirement for each CCG as rate 2. For Local Authority Modelling- ONS mid-year local authority a whole. Therefore, the 2022 projected whole CCG population was ward estimates 2002-2012 with the growth trend projected taken from another published dataset ‘ONS 2012 SNPP CCG Pop forward to 2022 (methodology as previously explained) Persons’. The projections based on ward-level data were sense- checked against these ONS published CCG total population projections to validate the methodology and use of distinct datasets. The variance between the two was found to be 1.38% which is within the acceptable 5% level for ONS Statistics

2. 2012 is the most recently published ONS local authority ward level population data. Looking back to 2002 allows for analysis of the growth trend. Planned housing developments were also factored in where applicable to ensure that this growth was incorporated. Hours of 40 hours per week based on Mon-Fri 9am-6pm operation Clinical 85% Utilisation Average length 12.5 minutes for consultation National benchmarked average appointment lengths for primary care consultation of 10 minutes for treatment consultation Average 5.5 (which includes 3.6 for GP and 1.9 for nurse) National average published by QRESEARCH and HSCIC within ‘Trends in number of GP Consultation in GP Practice’ document consultations The modelling provides the following outputs for each of the geographical areas of analysis and each are based on HBN 11-01 guidance for primary and community care facilities.  Number of Consultation/Examination Rooms  Number of Treatment Rooms  Clinical Space in m2  Public space/waiting areas in m2  Total GIA in m2 including planning, engineering and circulation Taking into account population growth and housing developments (where known) planned within the projected period, initial capacity modelling based on the above assumptions has identified a requirement for the following primary care infrastructure across the Pan-Staffordshire area in 2022:

520 208 11,650 m2 C/E Rooms Treatment Rooms Clinical Space

28,522 m2 40,172 m2 64,274 m2 Public Space Net Internal Area Gross Internal Area A full breakdown of this information for the current primary care estate is not known at this stage (i.e. quantity of specific rooms or clinical/public space ratio), but a gap analysis can be undertaken when this data is provided. The table below indicates the primary care infrastructure requirement in 2015 and 2022 based on ONS CCG population projection figures for each CCG within the Pan-Staffordshire area. The requirement for Stafford and Surrounds CCG includes additional population resulting from planned housing developments based on figures provided by Stafford Borough Council. Additional work to incorporate housing developments planned within other local authority areas into this base modelling is ongoing.

Infrastructure Requirement in 2015 based on population C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Cannock Chase 60 24 1334 3266 4600 7360 North Staffordshire 95 38 2135 5226 7360 11777 Stafford and 68 27 1522 3727 5249 8398 Surrounds Stoke-on-Trent 116 46 2594 6350 8944 14311 East Staffordshire 56 22 1258 3080 4337 6940 South East 100 40 2245 5495 7740 12384 Staffordshire & Seisdon Peninsula Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space Space Area (m2) Area (m2) (m2) (m2) Cannock Chase 61 24 1362 3335 4697 7515 North Staffordshire 97 39 2165 5301 7467 11947

Stafford and 76 30 1688 4132 5820 9310 Surrounds Stoke-on-Trent 118 47 2648 6484 9132 14611 East Staffordshire 59 23 1316 3221 4537 7259 South East 103 41 2311 5659 7971 12753 Staffordshire & Seisdon Peninsula

As previously indicated, capacity modelling was also completed for the local authority wards suggesting the greatest growth to 2022. The following tables outline the infrastructure requirements for these wards in 2022 within each of the Local Authority Districts constituting the Pan-Staffordshire area. Cannock Chase Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Hagley 3 1 64 156 219 350 Hawks Green 4 2 95 231 326 522 Norton Canes 4 1 82 202 284 454

East Staffordshire Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Burton 2 1 55 135 191 305 Anglesey 4 2 90 220 310 497 Eton Park 3 1 75 183 258 412 Lichfield Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Leomansley 6 2 127 310 437 699 St John’s 4 1 83 202 285 455 Alrewas and Fradley 3 1 75 184 259 414

Newcastle-under-Lyme Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Keele 2 1 53 129 182 291 Town 3 1 59 144 203 324 Thistleberry 3 1 66 163 229 366 South Staffordshire Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Huntington and 3 1 62 152 214 342 Hatherton Featherstone and 3 1 69 169 238 380 Shareshill Wombourne North and 3 1 72 176 247 396 Lower Penn

Stafford Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Milford 3 1 72 178 251 402 Forebridge 3 1 68 167 235 376 Stonefield and 3 1 69 169 238 381 Christchurch Staffordshire Moorlands Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Cheddleton 3 1 63 155 219 350 Leek South 3 1 66 161 227 363 Hamps Valley 1 0 20 49 69 110

Stoke-on-Trent Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Ford Green and 4 1 83 203 286 458 Smallthorne Blurton West and 3 1 78 191 269 431 Newstead Etruria and Hanley 4 1 84 205 288 462 Tamworth Infrastructure Requirement in 2022 based on population and housing developments C/E Treatment Clinical Public Net Internal Gross Internal Rooms Rooms Space (m2) Space (m2) Area (m2) Area (m2) Wilnecote 5 2 109 268 377 604 Spital 4 1 80 195 274 439 Bolehall 4 2 85 208 292 468

The gap analysis can help to understand whether new sites are required or whether the existing public service infrastructure is sufficient to meet demand in these areas. This will be shaped by understanding the geographical spread of the demand and whether this is aligned closely to new development. Outpatient Activity and Capacity Modelling

Consistent with emerging models transferring secondary care activity into the community where possible, an assessment will be made of the impact on infrastructure requirements resulting from a 15 or 30% transfer of outpatient activity from acute to community sites. The rationale for modelling 15 or 30% shifts is based on published reports by The Kings Fund which suggest that a shift in activity greater than 30% is not likely to be feasible and a shift in activity of less than 10-15% is not thought to be economically efficient. The two scenarios that will be modelled therefore provide realistic benchmarks. Outpatient activity data will be taken from NHS England quarterly published outpatient data which includes first appointments, follow ups and DNAs. The activity of providers within each CCG area will be gauged based on SHAPE mapping. Where a provider is operating across more than one CCG area, outpatient activity will be apportioned on the basis of population and growth in outpatient activity will be applied in alignment with population growth. The outpatient activity and capacity modelling is based on the following assumptions:  Appointment length of new and follow up appointments is not known so an average of 15 minutes was used based on national benchmarks  Sizes of rooms, circulation, plant etc. are as per HBN 11-01 (2011)  Assumed clinical utilisation of 85%

The diagram below illustrates the process:

NHS England quarterly Benchmarked national Additional infrastructure outpatient first and average appointment required if 15% or 30% of outpatient activity subsequent length for new/follow transfers from acute to attendance figures and up patients Output community sites within Baseline DNAs for providers in Number of each CCG area the Pan-Staffordshire attendances per capita Modelling outputs will area per annum include additional Gross Internal Area, number of Clinical utilisation C/E and treatment rooms Apportionment of required based on HBN 11-01 Considered Variables outpatient attendance figures based on population Current Developments and Proposed Bids Estate and Technology Transformation Fund (ETTF) bids To improve local access to clinical services, the CCG will continue to submit bids according to the timetable for the remaining three years of this national, centrally-funded initiative for the development of primary care premises.

ETTF bids for developments between April 2016 and March 2019 will be informed by the SEP assessment of the current estate. The LEF will invite practices to submit expressions of interest for proposals that meet national and local objectives. EoIs will be considered by the CCG with reference to service strategies, financial constraints and PCTF outcomes criteria – for 2016/17 these are:  increased capacity for primary care services out of hospital  commitment to a wider range of services as set out in the CCG’s commissioning intentions to reduce unplanned admissions to hospital  improving seven-day access to effective care  increased training capacity.

The LEF will seek out potential developments that could provide real transformation in primary care and OoH provision. (It is understood that there are plans to make ETTF regulations more flexible so as to create opportunities for increasingly ambitious projects.) Each CCG will develop proposals for 2016/17 bids in June 2016. These will then undergo a due diligence period by NHSE throughout July and the successful bide will be announced in early September 2016.

Stafford & Surrounds CCG Required Schemes

Practice Name Bid Type Summary of Bid

Rising Brook Surgery (Stafford) New Build The scheme will deliver a modern, purpose built health centre to replace the existing premises and community health facilities.

Weeping Cross Surgery (Stafford) New Build The scheme will deliver a modern, purpose built health centre to replace the existing premises, branch surgery and community health facilities.

Castlefields, Holmcroft & Mill Bank Extension x 3 This joint scheme will deliver extensions to Practices (Stafford) the existing purpose build premises to enable all 3 practices to expand to enable them to deliver medical services and patient choice to the expanding local population resulting from multiple planned housing developments.

Hazeldene Surgery (Great Haywood) New Build The scheme will deliver a modern, purpose built health centre to replace the existing premises and community health facilities.

Cannock Chase CCG Required Schemes

Practice Name / Scheme Bid Type Summary of Bid

Moss Street, Red Lion and GP Suite New Build The scheme will deliver a single, modern, Surgeries (Cannock) purpose built health centre to replace the existing premises currently occupied by 3 practices and community health facilities.

High Street Surgery (Cheslyn Hay) Extension This scheme will deliver an extension to the existing purpose built premises to create additional clinical accommodation to meet the needs of an increasing local population.

Staffordshire Connected (whole county Technology This scheme will support the transformation of on behalf of all 6 Staffordshire CCGs) service delivery across the Local Health Economy (Staffordshire) through innovative use of digital technology, providing health professionals with access to the information they need to deliver safe and efficient care. The 6 Staffordshire CCG’s are jointly submitting this bid in line with the collaboration of effort seen through the Staffordshire Sustainability and Transformation Plans (STP) and the Staffordshire Local Digital Roadmap. Practice Name / Scheme Bid Type Summary of Bid

AIR (Rugeley) Technology The scheme will deliver a single IP telephone system across 4 practices (including branch sites) to improve access to effective care. The system will allow ability to route calls at busy times and therefore can be answered quicker offering easier access. By joining up the healthcare professionals throughout the system will provide complete care for the patient which may be ways of triaging to other services within the community. South East Staffordshire & Seisdon Peninsular CCG Required Schemes

Practice Name Bid Type Summary of Bid

Fulfen & Spires Practices (Burntwood) New Build The scheme will deliver a single, modern, purpose built health centre to replace the existing premises and community health facilities. The scheme may facilitate a merger of the two practices.

Salters Meadow, Burntwood Health & New Build The scheme will deliver a single, modern, Wellbeing and Boney Hay Practices purpose built health centre to replace the (Burntwood) existing premises currently occupied by 3 practices and community health facilities.

Russell House Practice (Codsall) New Build This scheme will enable the practice to re- locate to modern, purpose built premises within the existing or new local authority premises. Westgate & Cloisters Practices New Build The scheme will deliver a single, modern, (Lichfield) purpose built health centre to replace the existing premises currently occupied by 2 practices and community health facilities.

Practice Name Bid Type Summary of Bid

Gravell Hill Practice (Womborne) Extension This scheme will deliver an extension to the existing purpose built premises along with internal modifications to create additional clinical accommodation. Tri-Links Practice (Tamworth) Extension x 2 This scheme will deliver an extension to two of the practices existing premises to create additional clinical accommodation.

Lakeside & Tamar Practices (Perton) New Build The scheme will deliver a single, modern, purpose built health centre to replace the existing premises currently occupied by 2 practices and community health facilities. North Staffordshire Required Schemes

Practice Name Bid Type Summary of Bid

Expansion of existing building; increase of 4 clinical/consulting rooms; Moorland Medical addition of an ambulance emergency exit/entrance at the rear of the building. Estate Centre The reception and waiting areas will be updated and enlarged including a confidentiality space which we currently don’t have.

Northern Staffordshire To develop a GP-led urgent care/primary care centre HUB Opposite RSUH Estate GP Federation Limited A&E at Child Development Centre or a build attached to the ED. Divide a ground floor clinical room into two new clinical rooms and convert a large ground floor room, previously used as an administrative office for Wolstanton Medical Estate Health Visitors and District Nurses, into a new clinical room. This will provide Centre two additional clinical rooms increasing clinical capacity and improving access especially to the disabled. Conversion of 2 small side examination rooms in to one consulting room for Leek Health Centre Estate use by the community matron and additional GP Hours – replace flooring and sinks in the nursing suite. The Village Surgery, Estate Loft Conversion to create additional clinical space Wolstanton

Well Street Medical Estate Improved access, disabled toilets and clinical room extension Centre R.J.Mitchell Medical Estate Expansion of 2 extra consulting rooms Centre Stoke on Trent Required Schemes

Practice Name Bid Type Summary of Bid South Longton - The scheme will deliver fit for purpose, state of the art primary care facilities Willowbank Surgery, Estate for the local community via a third party development new build funded by Longton Hall Surgery & One Medical Group. Replacing the current premises of the 3 practices Potteries Medical Centre/Cambridge Estate Practice Merge and New Building House Surgery Proposal to embed digital delivery of care via tablets (Ipads) held by the ANEW Locality Technology practice clinician as a service improvement when undertaking home visits to housebound patients Orchard Surgery Estate 4 additional consulting rooms to increase capacity Scheme 2 - this would involve an internal change and the addition of 2 Belgrave Medical Centre Estate consulting rooms to be built onto the existing building to allow both projects to take place Scheme 1 – this would involve an internal change to the existing building to Belgrave Medical Centre Estate add 2 additional consulting rooms in currently underutilised administrative space Goldenhill Medical To add an additional 2 consulting rooms. Increase the size of the waiting Estate Centre area and improve the reception area.

Norfolk Street Surgery Estate Conversion of administrative office to GP consulting room.

Trinity Medical Centre Estate Development of Roof Space to provide additional clinical consulting rooms.

Potteries Medical Centre Estate Building expansion to create an additional consulting room

To provide three additional clinical rooms within the internal space of the Mayfield Surgery Estate practice. There would be a minor extension to an end clinical room which would not require planning permission. Expand existing building by redesigning the layout of the ground floor and Adderley Green Surgery Estate creating a third floor consulting room East Staffordshire For East Staffordshire it is essential to have estates which are fit for purpose and future proofed to deliver effective general practice. Our estate needs to support the future direction of travel for primary care at scale, be of high quality and accessible for the population.

East Staffordshire Estates Priorities: • To support the development of purpose built flexible, multi-use premises that are adapted to changes in services capacity or demand to match the needs of our growing population. • To secure national funding to help ESCCG to move at pace and support the creation of an estate which will increase capacity for clinical services which can be delivered at scale and improve access to effective care outside of hospital. • As far as possible to future proof new developments anticipating further growth in demand over the following 10-20 years. How we will deliver: We plan to develop a hub and spoke model based around our emerging clusters, however we do not want to be tied in to a single approach solution which may not fit with our more rural practices.

Types of emerging models:

Traditional hub and spoke: Virtual Hub: • Practices would continue to offer the • Practices would continue to full range of Primary Care services offer the full range of Primary • A large care hub which would provide Care services extended services to all patents in the • Individual practices would offer cluster, which would be accessible extended services for all outside of core hours patients within the cluster

East Staffordshire Benefits: • We develop integrated, multi occupancy premises which include a range of providers and services but with sufficient room for growth/ expansion. • A collaborative approach to service delivery offers added resilience to smaller practices that struggle to offer extended services and will be implemented through cooperative working Our Clusters: The clusters would be serving populations in the range of 25,000 to 42,000 and possibly even larger over time. The opportunity this offers is to strengthen the role of GPs primarily as providers of care, co-ordinating the delivery of services on behalf of their patients and working in collaboration with others to provide joined-up services in the community.

Central Burton & Burton East Burton West & Uttoexter & surrounds Tutbury villages • Winshill • Trent Meadows • Dove River • Abbotts Bromley • Wetmore Road • Alrewas • Tutbury Practice • Balance Street • Bridge Street • Barton • Gordon Street • Northgate • Stapenhill • Yoxall • Carlton Group • Mill View • All Saints • Peel Croft

42,614 41,819 28,928 25,106

More detail about the emerging clusters is on the next slide.

East Staffordshire Central Burton and Tutbury Cluster: This cluster covers a large area Burton East Cluster: This cluster does cover a large area of inner Burton, from inner Burton to Sudbury. Sudbury can be found in a rural setting Winshill and Stapenhill with Stapenhill Surgery having a satellite surgery half way between Burton on Trent and Uttoxeter. in Rosliston (Derbyshire) • Current population of 42,614, • Current population of 42,819 • 5 General Practices, with 18 number of Partners and 5 salaried • 5 General Practices, with 14 number of Partners and 9 salaried Doctors, Doctors, • 7 practice sites : 5 main and 2 branch surgeries, • 6 practice sites : 5 main and 1 branch surgeries, • By 2031 this Cluster is expected to have an additional 1,644 dwellings • By 2031 this Cluster is expected to have an additional 2,500 dwellings

ETTF funding requirements: ETTF funding requirements: • 1 new purpose built health center/ primary care hub • Development of a nurse training hub • Various practice refurbishments, increase clinical and training • Various practice refurbishments, increase clinical and training capacity capacity (?) *1 dwelling = 2.5 persons *1 dwelling = 2.5 persons Burton West and Villages Cluster: This cluster covers a large area with 3 Uttoxeter and Surrounds Cluster: This cluster covers a large area in the of the 4 practices being located in local villages which limits choice but north west of the East Staffordshire area and includes the town of does provide a community identity. Trent Meadows Practice has 2 sites Uttoxeter who will see some major developments over the next 10 to 12 covering very different areas of Burton. years. • Current population of 28,928 • Current population of 25,106 • 4 General Practices, with 14 number of Partners and 4 salaried • 5 General Practices, with 12 number of Partners and 2 salaried Doctors, Doctors, • 5 practice sites : 4 main and 1 branch surgeries, • 5 practice sites : 5 main and 0branch surgeries, • By 2031 this cluster is expected to have an additional 2,580 dwellings • By 2031 this Cluster is expected to have an additional 1,500 dwellings

ETTF funding requirements: ETTF funding requirements: • 1 new purpose built health center/ primary care hub • Various practice refurbishments, increase clinical and training • Various practice refurbishments, increase clinical and training capacity (?) capacity *1 dwelling = 2.5 persons *1 dwelling = 2.5 persons East Staffordshire Estates ETTF required schemes:

Carlton Group: New Build Primary Care Hub Colocation of two practices initially in to purpose built primary care hub, which would be able to expand to increase number of practices and/or services to support the development of primary at scale.

Wetmore Road: Nurse Training Hub Creating a nurse training hub to develop a pipeline of suitably qualified nurses to deal with the ever growing demand of Primary Care and local population growth.

Trent meadows: Potential New Build Primary Care hub There are early talks about the potential of a development at the Stretton site, to accommodate the increase in population from the new housing developments expected in the next 5-10 years.

Tutbury Medical Centre: Refurbishment Two practice proposals for alterations to the reception area to improve patient experience.

Bridge Street surgery: Refurbishment Practice refurbishment to a number of clinical areas to improve quality and infection control. East Staffordshire Clinical Commissioning Group (ESCCG) Working with partners ESCCG is working in close collaboration with the development of the pan Staffordshire Estates Strategy and will be align to the vision with an Estates Portfolio. ESCCG Estates Portfolio with define the GP Practice estate and facilities across East Staffordshire. This will include: • Ownership and condition of the estate, • Housing developments, • Demographic and capacity alignment information, • Outline of the ETTF proposals which support ESCCGs vision for GP estate for 2016 -2021. The Estates Portfolio has been scoped through collaboration with Local Authority, East Staffs Borough Council, Derbyshire Dales Council and Derbyshire District Council. This collaborative working has provided an embryonic estates and facilities forum for ongoing collective working in partnership. Local Authority has an emerging care model for the elderly; the development of a Dementia Centre of excellence and new educational facilities to accommodate the growth in housing developments We are working together with partners to understand how we can the use of 106 monies to support health estate developments. East Staffordshire is bordered with Derbyshire on three sides of the county. Through working in partnership with the Derbyshire County Councils ESCCG is well sighted on future housing developments which may impact upon the GP Practices which are on the boundary of the CCG. Early discussions have also taken place with all of the Acute Trusts providers for East Staffordshire to ensure that the pan Staffordshire Estates strategy is aligned with the secondary care Estates Strategies. In accordance with the FYFV the CCG will work with provider organisations in the formulation of integrated strategies for long term preventative care and care out of hospital enabling rationalisation across the NHS estate and services being delivered at a local level directly to the community. Further ongoing discussions will be facilitated through the emerging estates and facilities forum. SEP Next Steps: Timetable and Milestones

June Dec Jun 17 2016/17 Stage 1 EFFT bids confirmed LEF confirm vision and support attained

Stage 2 Complete mapping, modelling and data work carried out to deliver vision Implement ETTF projects Stage 3 Finalise SEP with completed vision Continue to deliver on ETTF projects

Milestone 1 Milestone 2 Milestone 3 Appendices

1. Staffordshire CCGs map 2. GP Premises Survey 3. Survey results

Staffordshire CCGs GP Premises Survey Results of GP Questionnaire Responses - Analysis

 The first column indicates how many of the sites listed on the spreadsheet have provided responses.  The numbers for each category of question (e.g. type of property) may not equal 100% as some respondents may have given more than one response or not responded.

Tenure Condition of Property Type of Property Capacity Number Leasehold Freehold Excellent Good Satisfactory Poor Purpose Residential Health Other Capacity Desire to extend of % % % % % % Built % % Centre % to property to meet responses % increase increased demand list size from population % growth % Cannock Chase 13/31 77 23 31 46 23 0 46 8 38 15 62 69 East Staffs 20/22 40 55 25 45 20 0 45 20 45 15 45 70 North Staffs 20/37 20 70 20 70 5 5 65 25 10 5 45 45 SE Staffs and 29/38 52 34 7 45 28 21 31 17 41 3 34 62 Seisdon Stafford & 17/22 59 41 24 41 0 24 53 18 18 12 47 76 Surrounds Stoke-on-Trent 37/61 62 32 27 38 32 3 49 14 38 0 43 59